Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection Fraction
Background: In patients with preserved left ventricular ejection fraction (LVEF), small ventricular size has been associated with reduced functional capacity, but its impact on clinical outcomes is unclear. Objectives: The goal of this study was to determine the relationship between small heart size...
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Elsevier
2025-01-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X24007245 |
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| author | Stephanie J. Rowe, BBiomed, MD Elizabeth D. Paratz, MBBS, PhD Louise Fahy, MB, BCh, BAO Kristel Janssens, BNurs Luke W. Spencer, BBiomed(Hons) Paolo D’Ambrosio, MBBS Geoff Strange, PhD David L. Prior, MBBS(Hons), BMedSc, PhD David Playford, MBBS, PhD Andre La Gerche, MBBS, PhD |
| author_facet | Stephanie J. Rowe, BBiomed, MD Elizabeth D. Paratz, MBBS, PhD Louise Fahy, MB, BCh, BAO Kristel Janssens, BNurs Luke W. Spencer, BBiomed(Hons) Paolo D’Ambrosio, MBBS Geoff Strange, PhD David L. Prior, MBBS(Hons), BMedSc, PhD David Playford, MBBS, PhD Andre La Gerche, MBBS, PhD |
| author_sort | Stephanie J. Rowe, BBiomed, MD |
| collection | DOAJ |
| description | Background: In patients with preserved left ventricular ejection fraction (LVEF), small ventricular size has been associated with reduced functional capacity, but its impact on clinical outcomes is unclear. Objectives: The goal of this study was to determine the relationship between small heart size and premature mortality within a large multicenter adult patient cohort with transthoracic echocardiographic examinations. Methods: We divided 366,484 individuals with LVEF ≥50% (including a subset of 279,442 individuals with high-normal LVEF ≥60%) by sex and increasing quartiles for LV end-diastolic volume (LVEDV), LVEDV indexed to body surface area (LVEDVi), and LV end-diastolic diameter to assess associations with 5-year mortality through linkage with the National Death Index. Results: During approximately 2 million person-years of follow-up, 65,241 deaths occurred. Increasing LV chamber size was associated with reduced odds of 5-year all-cause mortality, particularly for higher LVEF. As compared with the larger quartiles, the smallest cardiac size quartiles were associated with higher 5-year all-cause mortality, even after adjusting for age. The smallest LVEDVi quartile was associated with a 14% to 18% higher odds of 5-year all-cause mortality, with a greater effect with high-normal LVEF. There was a U-shaped relationship between LV chamber size and all-cause mortality. For cardiovascular-related mortality, females in the smallest LVEDVi quartile had a 17% increased odds of mortality, which increased to 30% in those with LVEF ≥60%. In men, there was no significant association between smallest cardiac size and cardiovascular-related mortality. Conclusions: In individuals with normal LVEF, small ventricular size is associated with increased mortality, particularly among females and those with higher LVEF. |
| format | Article |
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| institution | OA Journals |
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| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | JACC: Advances |
| spelling | doaj-art-de2ce08877b04eb9a03a685beaf04e332025-08-20T01:56:23ZengElsevierJACC: Advances2772-963X2025-01-014110144410.1016/j.jacadv.2024.101444Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection FractionStephanie J. Rowe, BBiomed, MD0Elizabeth D. Paratz, MBBS, PhD1Louise Fahy, MB, BCh, BAO2Kristel Janssens, BNurs3Luke W. Spencer, BBiomed(Hons)4Paolo D’Ambrosio, MBBS5Geoff Strange, PhD6David L. Prior, MBBS(Hons), BMedSc, PhD7David Playford, MBBS, PhD8Andre La Gerche, MBBS, PhD9HEART Lab, St Vincent’s Institute of Medical Research, Fitzroy, Australia; Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Address for correspondence: Dr Stephanie J. Rowe, HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes Street Fitzroy, Victoria 3065, Australia.HEART Lab, St Vincent’s Institute of Medical Research, Fitzroy, Australia; Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, AustraliaHEART Lab, St Vincent’s Institute of Medical Research, Fitzroy, Australia; Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, AustraliaHEART Lab, St Vincent’s Institute of Medical Research, Fitzroy, Australia; Exercise and Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AustraliaHEART Lab, St Vincent’s Institute of Medical Research, Fitzroy, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, AustraliaHEART Lab, St Vincent’s Institute of Medical Research, Fitzroy, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, AustraliaSchool of Medicine, The University of Notre Dame, Fremantle, Western Australia, AustraliaDepartment of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, AustraliaSchool of Medicine, The University of Notre Dame, Fremantle, Western Australia, AustraliaHEART Lab, St Vincent’s Institute of Medical Research, Fitzroy, Australia; Heart, Exercise and Research Trials, Victor Chang Cardiovascular Research Institute, Darlinghurst, Australia; Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, AustraliaBackground: In patients with preserved left ventricular ejection fraction (LVEF), small ventricular size has been associated with reduced functional capacity, but its impact on clinical outcomes is unclear. Objectives: The goal of this study was to determine the relationship between small heart size and premature mortality within a large multicenter adult patient cohort with transthoracic echocardiographic examinations. Methods: We divided 366,484 individuals with LVEF ≥50% (including a subset of 279,442 individuals with high-normal LVEF ≥60%) by sex and increasing quartiles for LV end-diastolic volume (LVEDV), LVEDV indexed to body surface area (LVEDVi), and LV end-diastolic diameter to assess associations with 5-year mortality through linkage with the National Death Index. Results: During approximately 2 million person-years of follow-up, 65,241 deaths occurred. Increasing LV chamber size was associated with reduced odds of 5-year all-cause mortality, particularly for higher LVEF. As compared with the larger quartiles, the smallest cardiac size quartiles were associated with higher 5-year all-cause mortality, even after adjusting for age. The smallest LVEDVi quartile was associated with a 14% to 18% higher odds of 5-year all-cause mortality, with a greater effect with high-normal LVEF. There was a U-shaped relationship between LV chamber size and all-cause mortality. For cardiovascular-related mortality, females in the smallest LVEDVi quartile had a 17% increased odds of mortality, which increased to 30% in those with LVEF ≥60%. In men, there was no significant association between smallest cardiac size and cardiovascular-related mortality. Conclusions: In individuals with normal LVEF, small ventricular size is associated with increased mortality, particularly among females and those with higher LVEF.http://www.sciencedirect.com/science/article/pii/S2772963X24007245cardiac sizeheart failureHFpEFHFrEF |
| spellingShingle | Stephanie J. Rowe, BBiomed, MD Elizabeth D. Paratz, MBBS, PhD Louise Fahy, MB, BCh, BAO Kristel Janssens, BNurs Luke W. Spencer, BBiomed(Hons) Paolo D’Ambrosio, MBBS Geoff Strange, PhD David L. Prior, MBBS(Hons), BMedSc, PhD David Playford, MBBS, PhD Andre La Gerche, MBBS, PhD Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection Fraction JACC: Advances cardiac size heart failure HFpEF HFrEF |
| title | Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection Fraction |
| title_full | Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection Fraction |
| title_fullStr | Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection Fraction |
| title_full_unstemmed | Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection Fraction |
| title_short | Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection Fraction |
| title_sort | small heart size and premature death in 366 484 individuals with normal ejection fraction |
| topic | cardiac size heart failure HFpEF HFrEF |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X24007245 |
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